Alternate Site Surge Capacity in Times of Public Health Disaster Maintains Trauma Center and Emergency Department Integrity: Hurricane Katrina

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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Change Management at the Hospital Front Door: Integrating Automatic Patient Tracking in a High Volume Emergency Department and Level 1 Trauma Center

Nurse Leader ◽

10.1016/j.mnl.2007.07.002 ◽

2008 ◽

Vol 6 (2) ◽

pp. 52-57 ◽

Cited By ~ 2

Author(s):

Linda Laskowski-Jones

Keyword(s):

Emergency Department ◽

Change Management ◽

Trauma Center ◽

High Volume ◽

Patient Tracking ◽

Front Door ◽

Level 1 ◽

Level 1 Trauma Center

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The Minimization of Public Health Risks in Newspapers after Hurricane Katrina

Communication Research Reports ◽

10.1080/08824090802440162 ◽

2008 ◽

Vol 25 (4) ◽

pp. 266-281 ◽

Cited By ~ 7

Author(s):

Elisia L. Cohen ◽

Santosh Vijaykumar ◽

Ricardo Wray ◽

Ajlina Karamehic-Muratovic

Keyword(s):

Public Health ◽

Hurricane Katrina ◽

Health Risks ◽

Public Health Risks

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Transitions in “Privatized” Prison Health Systems: Emergency Department Visits and Hospitalizations Among Incarcerated People in Florida, 2011–2018

American Journal of Public Health ◽

10.2105/ajph.2020.305988 ◽

2021 ◽

pp. e1-e4

Author(s):

Jessica L. Adler ◽

Weiwei Chen ◽

Timothy F. Page

Keyword(s):

Public Health ◽

Health Care ◽

Emergency Department ◽

Hospital Discharge ◽

Emergency Department Visits ◽

Care Utilization ◽

Discharge Data ◽

Prison Health ◽

Discharge Rates ◽

Care Problems

Objectives. To examine rates of emergency department (ED) visits and hospitalizations among incarcerated people in Florida during a period when health care management in the state’s prisons underwent transitions. Methods. We used Florida ED visit and hospital discharge data (2011–2018) to depict the trend in ED visit and hospital discharge rates among incarcerated people. We proxied incarcerated people using individuals admitted from and discharged or transferred to a court or law enforcement agency. We fitted a regression with year indicators to examine the significance of yearly changes. Results. Among incarcerated people in Florida, ED visit rates quadrupled, and hospitalization rates doubled, between 2015 and 2018, a period when no similar trends were evident in the nonincarcerated population. Public Health Implications. Increasing the amount and flexibility of payments to contractors overseeing prison health services may foster higher rates of hospital utilization among incarcerated people and higher costs, without addressing major quality of care problems. Hospitals and government agencies should transparently report on health care utilization and outcomes among incarcerated people to ensure better oversight of services for a highly vulnerable population. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e4. https://doi.org/10.2105/AJPH.2020.305988 )

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Emerging Disease Syndromic Surveillance for Hurricane Katrina Evacuees Seeking Shelter in Houston's Astrodome and Reliant Park Complex

Public Health Reports ◽

10.1177/003335490912400304 ◽

2009 ◽

Vol 124 (3) ◽

pp. 364-371 ◽

Cited By ~ 31

Author(s):

Kristy O. Murray ◽

Cindy Kilborn ◽

Mary desVignes-Kendrick ◽

Erin Koers ◽

Valda Page ◽

...

Keyword(s):

Public Health ◽

Infectious Diseases ◽

Hurricane Katrina ◽

New Orleans ◽

Acute Gastroenteritis ◽

Surveillance System ◽

Syndromic Surveillance ◽

Emerging Disease ◽

Health Concern ◽

Public Health Concern

Transmission of infectious diseases became an immediate public health concern when approximately 27,000 New Orleans-area residents evacuated to Houston's Astrodome and Reliant Park Complex following Hurricane Katrina. This article presents a surveillance system that was rapidly developed and implemented for daily tracking of various symptoms in the evacuee population in the Astrodome “megashelter.” This system successfully confirmed an outbreak of acute gastroenteritis and became a critical tool in monitoring the course of this outbreak.

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Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015

Public Health Reports ◽

10.1177/0033354917707934 ◽

2017 ◽

Vol 132 (1_suppl) ◽

pp. 73S-79S ◽

Cited By ~ 8

Author(s):

Elizabeth R. Daly ◽

Kenneth Dufault ◽

David J. Swenson ◽

Paul Lakevicius ◽

Erin Metcalf ◽

...

Keyword(s):

Public Health ◽

Emergency Department ◽

New Hampshire ◽

Syndromic Surveillance ◽

Situational Awareness ◽

The United States ◽

Chief Complaint ◽

Public Health Response ◽

Syndromic Surveillance System ◽

Icd Codes

Objectives: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. Methods: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire’s syndromic surveillance ED data system by querying for (1) chief complaint text related to the words “fentanyl,” “heroin,” “opiate,” and “opioid” and (2) opioid-related International Classification of Diseases ( ICD) codes. We then analyzed the data to calculate frequencies of opioid-related ED encounters by age, sex, residence, chief complaint text values, and ICD codes. Results: Opioid-related ED encounters increased by 70% during the study period, from 3300 in 2011 to 5603 in 2015; the largest increases occurred in adults aged 18-29 and in males. Of 20 994 total opioid-related ED visits, we identified 18 554 (88%) using ICD code alone, 690 (3%) using chief complaint text alone, and 1750 (8%) using both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and nonspecific words, with the most common being “pain” (n = 3335, 18%), “overdose” (n = 1555, 8%), “suicidal” (n = 816, 4%), “drug” (n = 803, 4%), and “detox” (n = 750, 4%). Heroin-specific encounters increased by 827%, from 4% of opioid-related encounters in 2011 to 24% of encounters in 2015. Conclusions: Opioid-related ED encounters in New Hampshire increased substantially from 2011 to 2015. Data from New Hampshire’s ED syndromic surveillance system provided timely situational awareness to public health partners to support the overall response to the opioid epidemic.

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Why did the children stop coming? Reasons for paediatric emergency department attendance decrease during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study

10.1101/2021.03.30.21254661 ◽

2021 ◽

Author(s):

Matthew Breckons ◽

Sophie Thorne ◽

Rebecca Walsh ◽

Sunil Bhopal ◽

Stephen Owens ◽

...

Keyword(s):

Public Health ◽

Emergency Department ◽

United Kingdom ◽

Substantial Reduction ◽

Healthcare Services ◽

Urgent Care ◽

List Type ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Health Messaging

AbstractObjectiveTo explore parent’s experiences and views relating to their use of children’s emergency healthcare services during the Covid-19 pandemic.DesignQualitative telephone interview study using in-depth interviews, based on the principles of grounded theory. Recorded, transcribed verbatim, managed in NVivo version 12, analysed by thematic analysis.SettingNorth East England, United Kingdom.ParticipantsParents of children aged 0-8 years.FindingsThree major themes emerged from the interview data: Risk to children and families, Sources of Information, and Making Healthcare-seeking Decisions. These themes encompassed a range of intellectual and emotional responses in the way that parents interpreted information related to Covid-19, and their sense of responsibility towards family and wider society.ConclusionsTogether these themes aid understanding of the changes in paediatric emergency department attendances reported in the early months of the Covid-19 pandemic in the UK. The analysis suggests that public health messaging directed at those seeking urgent care for children may be inadequate and lead to adverse consequences, the impacts of which require further study and refinement.What is known about the subjectFollowing lockdown, there was a substantial reduction in the number of children taken to unscheduled medical care across the countryDelays in presentation can impact on children’s healthIt is not known what parents’ views are on accessing emergency health services in a pandemic situationWhat this study addsParents had to weigh up a number of information sources before deciding on whether to take their child to hospitalPublic health messaging directed at those seeking urgent care for children may lead to a reduction in use of emergency healthcare servicesFuture lockdowns should implement focussed strategies, optimising use of emergency healthcare services, whilst avoiding harm.

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Interrupted time Series Design to Evaluate ICD-9-CM to ICD-10-CM Coding Changes on Trends in Colorado Emergency Department visits Related to Traumatic Brain Injury

10.21203/rs.3.rs-134764/v1 ◽

2020 ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

P Value ◽

Icd 10 ◽

The Usa ◽

Definition Of

Abstract Background. The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the USA led public health professionals to propose a surveillance definition of traumatic brain injury (TBI) that uses ICD-10-CM codes. The proposed definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI definition. The purpose of this study was to evaluate this change in surveillance methods on monthly rates of TBI-related emergency department visits in Colorado from 2012 to 2017.Results. The monthly rate of TBI-related emergency department visits in the transition month to ICD-10-CM (October 2015) decreased 41 visits per 100,000 population (p-value <0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. Conclusion. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates over time. The findings inform estimation of TBI magnitude based on ICD coded data and decisions about allocating TBI resources based on an estimated TBI magnitude.

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Management of Evacuee Surge from a Disaster Area: Solutions to Avoid Non-Emergent, Emergency Department Visits

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004702 ◽

2007 ◽

Vol 22 (3) ◽

pp. 220-223 ◽

Cited By ~ 9

Author(s):

Charlene B. Irvin ◽

Jenny G. Atas

Keyword(s):

Emergency Department ◽

Hurricane Katrina ◽

The United States ◽

Emergency Department Visits ◽

Disaster Area ◽

Medical Evaluation ◽

Number Of Patients ◽

Medical Directors ◽

States Experience ◽

New Location

AbstractIntroduction:Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral).Objective:The objective of this study was to describe a successful multidisciplinary Hurricane Katrina Evacuation Center, explain the services offered, and determine the center's effects on referrals to local EDs.Methods:Data were collected concerning the number of patients utilizing the medical evaluation center and compared to the total number of evacuees to determine the proportion that utilized medical care. The data concerning patients given prescriptions was obtained by the estimation of the two medical directors of the Center, and therefore, is inexact.Results:During the five weeks the center was operational, 631 of 716 evacuees (88%) requested medical evaluation, and >80% of those had prescriptions written. Only four (<1%) patients were transported to local EDs.Conclusion:An evacuee evaluation center provides a convenient non-ED alternative for evacuees to address their non-emergent medical concerns and can be used to ease their transition to a new location.

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